The current opioid epidemic is devastating our communities. The American Medical Association’s Task Force on opioid addiction has identified stigma as a primary target of intervention for mitigating this epidemic. Stigma is a mark of disgrace or being objectionable. Experiences of stigma and resulting shame serve only to fuel health inequities experienced by people with opioid addiction. Emergency Medical Services (EMS) have an important role to play in mitigating this epidemic as entry-level providers in the healthcare system. The quality of that patient-provider encounter had the potential to shift intrinsic motivation to seek and maintain addiction treatment. Patient-centered care is identified as supporting therapeutic communication and is well-suited for rural EMS operations in Maine. The purpose of this research was to examine predictors of intention to provide patient-centered care to people experiencing opioid addiction and overdose (OAO) among EMS providers in the state of Maine. A cross-sectional online survey of currently licensed EMS providers offered a direct measure of intention to give patient-centered care to people experiencing OAO. Multiple regression analysis identified four predictor variables for intention: job satisfaction, exploring patient perspective, sharing information and power, and dealing with communicative challenges. The fitted model resulted in a significant R2 = .529, (F (4, 734) = 226.381, p < .001) exceeding the critical F statistic (F (4,739) = 2.384, p = .05), thus confirming the predictive value of the coefficients. Results suggested that EMS providers at all license levels will benefit from interventions that expand their knowledge of the medical definition of addiction and patient-centered care. EMS providers will also benefit from adopting approaches that support exploring the patient perspective and sharing information and power such as Motivational Interviewing and human performance strategies to develop awareness of socially conditioned biases that moderate provider attitudes. These evidence-based interventions could elevate the standard of care provided by EMS and reduce experiences of stigma in the patient-provider encounter. Reductions in stigma increase self-worth and prime motivation to seek and maintain treatment, thereby closing the treatment gap that exists for those experiencing opioid addiction in the state of Maine.

Abstract available through Clinical Pharmacology in Drug Development.

Abstract available through Clinical Pharmacology in Drug Development.

Domestic violence continues to destroy individuals and families, leaving generations to follow repeating the same patterns. There are several services offered to help aid in the healing and recovery process. This was a qualitative, explorative study which examined the reasons that male perpetrators commit domestic violence in heterosexual relationships. Additionally, this study evaluated the support services and coping mechanisms that the men found to be helpful and not so helpful. Five men participated in face-to-face interviews to share their personal experience with domestic violence. Most of the men believed that their domestic violence was linked to learned behavior they witnessed in their family of origin. All the men interviewed stated that most of their recovery came from their faith, and they added that counseling, praying, the support of other men, mentors, pastors, and encouragement received, all contributed to their healing. Implications for future social work research, practice, policy, and programming are discussed.

Narratives of 'being Maori in addiction' have developed in a context in which Maori have been constituted as both 'drunken savages' and 'traditionally' abstinent. Discourses of colonialism and ongoing marginalisation, not to mention resistance, have been most salient in Maori narratives, while those focused on 'cultural deficit' have been more prominent within hegemonic narratives. The goal of the current thesis was to increase understanding of the construction of being Maori in addiction' by: i) identifying key discursive resources used to constitute related subject positions; and ii) identifying the ways in which such resources were deployed to accomplish particular tasks. A review of influential texts identified several core discourses, which located Maori within 'traditions' of collectivity, spirituality and connection with the land. However, the ongoing impact of colonisation, including contemporary alienation from 'tradition', and construction of Maori as the inferior 'other' within hegemonic narratives were prominent. Discourses of addiction have characteristically been based on biological notions of 'disease' and 'disorder', however, psychosocial discourse has become prominent more recently. The '12 Steps' of Alcoholic Anonymous, which provided the primary resource for participants with regard to 'addiction', also includes explicit discourses of spirituality. The current thesis was implemented within a methodological framework, kaupapa Maori. In this context deconstructive discourse analysis was identied as the most appropriate means of analysing interview data gathered from 11 men attending a 'addiction treatment' programme. The results indicated that while 'tradition' was central to narratives of 'being Maori', dicources of alienation and loss were equally salient. In terms of 'addiction', discourses of genetic inheritance were most prominent, although psychosocially constituted 'underlying issues' were also clearly located as being important. Such 'issues' were linked to both general life experiences and 'being Maori'. 'Treatment' narratives revolved around transformative narratives of 'self'. As participants disconnected themselves from 'addiction' and 'underlying issues', they reconnected with their positive ;essential self', previously compromised by 'addiction'. Two main discourses were utilised in terms of the relationship between 'being Maori' and 'addiction'. The first, deployed in aetiological narratives, constituted an inevitable link between 'being Maori' and substance use. The second, more prominent in 'treatment' narratives, located substance use as antithetical to 'Maori culture'. While both Maori and 12 Step 'traditions' were highlighted in participants' narratives, the latter tended to be privileged. 'Being Maori' was identified as important, or at least relevant, however, the opportunity to engage with integrated indigenised narratives of 'addiction' appeared to be limited by several factors. Essentialist 'tradition', for example, tended to be uncritically privileged within discourses that failed to account for contemporary 'diverse Maori realities', ignoring the complexities of relations between and within Te Ao Maori and Te Ao Pakeha. Additionally, '12 Step' discourses of 'treatment' limited construction of more broadly focused narratives of 'recovery'. Overall, the results indicated a clear need for Maori 'addiction treatments' to avoid essentialist notions of 'tradition' and support integrated narratives of 'being Maori in addication', which reflect the varied needs, capacity and experiences of individuals and whanau.

Thesis (M.S.)--Brigham Young University. Dept. of Marriage and Family Therapy, 2006. / Includes bibliographical references (p. 63-72).

<p>This study presents a discursive journey with regard to the risk and protective factors confronting individuals who engage in methamphetamine use within the Manenberg area. Given that this journey requires a cautious and sensitive approach to the meaning making of the lived experiences of the six (6) individual users (the informant base) / the study adopted an analysis process that would allow for a guided &ldquo / tour&rdquo / of these experiences. In doing so, the study made use of the grounded theory method that allowed for this guided &ldquo / tour&rdquo / to be fully anchored in the collected data. External to this data, and once the data emerged as engageable themes, the study introduced, relevantly so, Bronfenbrenner&rsquo / s social-ecological model of human development, so to multiply and deepen the meanings embedded within the data. The merging of this external frame, provided by Bronfenbrenner&rsquo / s model, and the rich data provided by the six (6) informants, uncovered critical themes in understanding the risk and protective factors at play within Manenberg. These themes relate to the historical identity of Manenberg, given the history of Apartheid, the role of the local community and its perceived tolerance of the practice of drug use, which is further echoed in the identity of the family and its limited ability to support drug users in the face of ever-growing poverty. The themes also uncovered the bipolarity in the practice of drug trade and gangsterism as serving a subsistence function, at one level, and an exploitative function at another. Furthermore, the study solidified traditional views that the peer collective is, indeed, a critical actor on the stage of drug use and that the individual (as an actor) continues to be confronted by a script of poverty and disillusionment. This script, as will be illustrated, is also active in preconceived notions of gender stratification.</p>

The variety of ways in which child abuse is currently defined hampers efforts to capture the prevalence of child abuse and seriously undermines research efforts. Professionals and researchers agree that the definition of child abuse is problematic and call for a concerted effort to address the problem. The goal of this study was to contribute to our understanding of child abuse by giving voice to individuals who labeled their childhood experiences as abusive. In-depth, unstructured interviews explored their childhood experiences, and the process by which they arrived at their decision to label these experiences as abusive. The categories and properties that emerged from the analysis of these narratives were tested against the narratives of individuals who shared similar childhood experiences but who did not label their experiences as abusive. I used the principles and methods of grounded theory to guide the collection, analysis and interpretation of the data. <p>As a result of the analysis, a theory was developed whereby child abuse is best described as a dynamic process that occurs in the interaction between a child and his or her parents as well as a child and his or her community. It is a struggle for control that begins with a parent's need for control that escalates over time into out-of-control behaviors as a child attempts to regain control through a variety of strategies that, over time, also become out of control. Stressors, both pre-existing and on-going, play a pivotal role in initiating and maintaining the child abuse process. Isolation, both social and psychological, is central to the experience of abuse and leads to the labeling of abuse. The experience of child abuse is one of being dehumanized or robbed of a sense of self. A discussion of this theory in relation to present models of abuse, the intergenerational transmission of abuse, interventions and directions forfuture research follows the presentation of the theory.

The variety of ways in which child abuse is currently defined hampers efforts to capture the prevalence of child abuse and seriously undermines research efforts. Professionals and researchers agree that the definition of child abuse is problematic and call for a concerted effort to address the problem. The goal of this study was to contribute to our understanding of child abuse by giving voice to individuals who labeled their childhood experiences as abusive. In-depth, unstructured interviews explored their childhood experiences, and the process by which they arrived at their decision to label these experiences as abusive. The categories and properties that emerged from the analysis of these narratives were tested against the narratives of individuals who shared similar childhood experiences but who did not label their experiences as abusive. I used the principles and methods of grounded theory to guide the collection, analysis and interpretation of the data. <p>As a result of the analysis, a theory was developed whereby child abuse is best described as a dynamic process that occurs in the interaction between a child and his or her parents as well as a child and his or her community. It is a struggle for control that begins with a parent's need for control that escalates over time into out-of-control behaviors as a child attempts to regain control through a variety of strategies that, over time, also become out of control. Stressors, both pre-existing and on-going, play a pivotal role in initiating and maintaining the child abuse process. Isolation, both social and psychological, is central to the experience of abuse and leads to the labeling of abuse. The experience of child abuse is one of being dehumanized or robbed of a sense of self. A discussion of this theory in relation to present models of abuse, the intergenerational transmission of abuse, interventions and directions forfuture research follows the presentation of the theory.

Thesis (Ph. D.)--University of Texas at Austin, 1999. / Vita. Includes bibliographical references (leaves 312-347). Available also in a digital version from Dissertation Abstracts.